Phaco advancements cut surgical time

San Francisco-Physicians who wonder if they should make the investment in a new model of surgical system they currently use and like, the answer could be yes. Data presented by Barry Schechter, MD, showed a 22% time savings in uncomplicated cataract procedures with new equipment.

“As phacoemulsification systems continue to improve, they are getting better at both efficiency and yield,” said Dr. Schechter, of Florida Eye Microsurgical Institute, Boynton Beach, FL. “We were happy with our existing surgical system, but we decided to upgrade to take advantage of the new technology available.”

Dr. Schechter presented the results of a retrospective comparison of surgical times using a phacoemulsification system (Millennium) and an updated system (Stellaris, both made by Bausch + Lomb).

The study compared six randomly selected surgical days for three surgeons. Three of the days used the Millennium system and three days used the Stellaris system. The Stellaris days were chosen about 3 months after adoption to allow surgeons to master the new equipment.

All of the surgical days used in the comparison included at least 12 uncomplicated procedures, defined as no limbal relaxing incisions, no vitrectomies, and no intraoperative devices. Other than the updated surgical system, other variables were unchanged, including surgical technique, operating room staff, IOLs implanted, incision sizes, and viscoelastic used. The outcome measured was time per procedure for each surgeon using the two different systems.

Improvements in the Stellaris system include faster response time, an increased stroke length for the phaco needle, a wireless foot pedal, and a more ergonomic hand piece.

The learning curve for the three surgeons on the Stellaris was almost identical, Dr. Schechter said. During the first 45 cases, surgical time declined by an average of 0.34 minutes for every 10 cases, then stabilized. Overall, the mean time per surgery was 8.42 minutes with the Millennium and 6.58 minutes with the Stellaris. The time difference of nearly 2 minutes per eye represents a 22% reduction, with is both statistically (p < 0.001) and clinically significant.

“Improvements in fluidics and cutting efficiency contributed to the reduced surgical time,” Dr. Schechter said. “Surgeons may be able to increase their efficiency in the operating room and improve patient flow with the new technology compared [with] the previous generation. And we can assume that less surgical time will translate into less inflammation and improved surgical outcomes for our patients.”

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